Provider Demographics
NPI:1629445952
Name:KOH, LILLY CHAN (DPT)
Entity Type:Individual
Prefix:
First Name:LILLY
Middle Name:CHAN
Last Name:KOH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 PIERRE RD
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-2531
Mailing Address - Country:US
Mailing Address - Phone:909-468-0438
Mailing Address - Fax:909-992-3303
Practice Address - Street 1:138 PIERRE RD
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-2531
Practice Address - Country:US
Practice Address - Phone:909-468-0438
Practice Address - Fax:909-992-3303
Is Sole Proprietor?:No
Enumeration Date:2015-08-21
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT42770225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT42770OtherPHYSICAL THERAPY CA LICENSE